The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

GBD 2017 Pancreatic Cancer Collaborators, Akram Pourshams, Sadaf G Sepanlou, Kevin S Ikuta, Catherine Bisignano, Saeid Safiri, Gholamreza Roshandel, Mehdi Sharif, Morteza Khatibian, Christina Fitzmaurice, Molly R Nixon, Nooshin Abbasi, Mohsen Afarideh, Elham Ahmadian, Tomi Akinyemiju, Fares Alahdab, Tahiya Alam, Vahid Alipour, Christine A Allen, Nahla Hamed Anber, Alireza Ansari-Moghaddam, Jalal Arabloo, Alaa Badawi, Mojtaba Bagherzadeh, Yaschilal Muche Belayneh, Belete Biadgo, Ali Bijani, Antonio Biondi, Tone Bjørge, Antonio M Borzì, Cristina Bosetti, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Giulia Carreras, Félix Carvalho, Jee-Young J Choi, Dinh-Toi Chu, Anh Kim Dang, Ahmad Daryani, Dragos Virgil Davitoiu, Gebre Teklemariam Demoz, Rupak Desai, Subhojit Dey, Hoa Thi Do, Huyen Phuc Do, Aziz Eftekhari, Alireza Esteghamati, Farshad Farzadfar, Eduarda Fernandes, Irina Filip, Florian Fischer, Masoud Foroutan, Mohamed M Gad, Silvano Gallus, Birhanu Geta, Giuseppe Gorini, Nima Hafezi-Nejad, James D Harvey, Milad Hasankhani, Amir Hasanzadeh, Soheil Hassanipour, Simon I Hay, Hagos D Hidru, Chi Linh Hoang, Sorin Hostiuc, Mowafa Househ, Olayinka Stephen Ilesanmi, Milena D Ilic, Seyed Sina Naghibi Irvani, Nader Jafari Balalami, Spencer L James, Farahnaz Joukar, Amir Kasaeian, Tesfaye Dessale Kassa, Andre Pascal Kengne, Rovshan Khalilov, Ejaz Ahmad Khan, Amir Khater, Fatemeh Khosravi Shadmani, Jonathan M Kocarnik, Hamidreza Komaki, Ai Koyanagi, Vivek Kumar, Carlo La Vecchia, Platon D Lopukhov, Farzad Manafi, Navid Manafi, Ana-Laura Manda, Fariborz Mansour-Ghanaei, Dhruv Mehta, Varshil Mehta, Toni Meier, Hagazi Gebre Meles, Getnet Mengistu, Tomasz Miazgowski, Mehdi Mohamadnejad, Abdollah Mohammadian-Hafshejani, Milad Mohammadoo-Khorasani, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Lorenzo Monasta, Maryam Moossavi, Rahmatollah Moradzadeh, Gurudatta Naik, Ionut Negoi, Cuong Tat Nguyen, Long Hoang Nguyen, Trang Huyen Nguyen, Andrew T Olagunju, Tinuke O Olagunju, Alyssa Pennini, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Mahdi Rahimi, Goura Kishor Rath, David Laith Rawaf, Salman Rawaf, Robert C Reiner Jr, Nima Rezaei, Aziz Rezapour, Anas M Saad, Seyedmohammad Saadatagah, Amirhossein Sahebkar, Hamideh Salimzadeh, Abdallah M Samy, Juan Sanabria, Arash Sarveazad, Monika Sawhney, Mario Sekerija, Pavel Shabalkin, Masood Ali Shaikh, Rajesh Sharma, Sara Sheikhbahaei, Reza Shirkoohi, Sudeep K Siddappa Malleshappa, Mekonnen Sisay, Kjetil Soreide, Sergey Soshnikov, Rasoul Sotoudehmanesh, Vladimir I Starodubov, Michelle L Subart, Rafael Tabarés-Seisdedos, Degena Bahray Bahrey Tadesse, Eugenio Traini, Bach Xuan Tran, Khanh Bao Tran, Irfan Ullah, Marco Vacante, Amir Vahedian-Azimi, Elena Varavikova, Ronny Westerman, Dawit Dawit Zewdu Wondafrash, Rixing Xu, Naohiro Yonemoto, Vesna Zadnik, Zhi-Jiang Zhang, Reza Malekzadeh, Mohsen Naghavi, GBD 2017 Pancreatic Cancer Collaborators, Akram Pourshams, Sadaf G Sepanlou, Kevin S Ikuta, Catherine Bisignano, Saeid Safiri, Gholamreza Roshandel, Mehdi Sharif, Morteza Khatibian, Christina Fitzmaurice, Molly R Nixon, Nooshin Abbasi, Mohsen Afarideh, Elham Ahmadian, Tomi Akinyemiju, Fares Alahdab, Tahiya Alam, Vahid Alipour, Christine A Allen, Nahla Hamed Anber, Alireza Ansari-Moghaddam, Jalal Arabloo, Alaa Badawi, Mojtaba Bagherzadeh, Yaschilal Muche Belayneh, Belete Biadgo, Ali Bijani, Antonio Biondi, Tone Bjørge, Antonio M Borzì, Cristina Bosetti, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Giulia Carreras, Félix Carvalho, Jee-Young J Choi, Dinh-Toi Chu, Anh Kim Dang, Ahmad Daryani, Dragos Virgil Davitoiu, Gebre Teklemariam Demoz, Rupak Desai, Subhojit Dey, Hoa Thi Do, Huyen Phuc Do, Aziz Eftekhari, Alireza Esteghamati, Farshad Farzadfar, Eduarda Fernandes, Irina Filip, Florian Fischer, Masoud Foroutan, Mohamed M Gad, Silvano Gallus, Birhanu Geta, Giuseppe Gorini, Nima Hafezi-Nejad, James D Harvey, Milad Hasankhani, Amir Hasanzadeh, Soheil Hassanipour, Simon I Hay, Hagos D Hidru, Chi Linh Hoang, Sorin Hostiuc, Mowafa Househ, Olayinka Stephen Ilesanmi, Milena D Ilic, Seyed Sina Naghibi Irvani, Nader Jafari Balalami, Spencer L James, Farahnaz Joukar, Amir Kasaeian, Tesfaye Dessale Kassa, Andre Pascal Kengne, Rovshan Khalilov, Ejaz Ahmad Khan, Amir Khater, Fatemeh Khosravi Shadmani, Jonathan M Kocarnik, Hamidreza Komaki, Ai Koyanagi, Vivek Kumar, Carlo La Vecchia, Platon D Lopukhov, Farzad Manafi, Navid Manafi, Ana-Laura Manda, Fariborz Mansour-Ghanaei, Dhruv Mehta, Varshil Mehta, Toni Meier, Hagazi Gebre Meles, Getnet Mengistu, Tomasz Miazgowski, Mehdi Mohamadnejad, Abdollah Mohammadian-Hafshejani, Milad Mohammadoo-Khorasani, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Lorenzo Monasta, Maryam Moossavi, Rahmatollah Moradzadeh, Gurudatta Naik, Ionut Negoi, Cuong Tat Nguyen, Long Hoang Nguyen, Trang Huyen Nguyen, Andrew T Olagunju, Tinuke O Olagunju, Alyssa Pennini, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Mahdi Rahimi, Goura Kishor Rath, David Laith Rawaf, Salman Rawaf, Robert C Reiner Jr, Nima Rezaei, Aziz Rezapour, Anas M Saad, Seyedmohammad Saadatagah, Amirhossein Sahebkar, Hamideh Salimzadeh, Abdallah M Samy, Juan Sanabria, Arash Sarveazad, Monika Sawhney, Mario Sekerija, Pavel Shabalkin, Masood Ali Shaikh, Rajesh Sharma, Sara Sheikhbahaei, Reza Shirkoohi, Sudeep K Siddappa Malleshappa, Mekonnen Sisay, Kjetil Soreide, Sergey Soshnikov, Rasoul Sotoudehmanesh, Vladimir I Starodubov, Michelle L Subart, Rafael Tabarés-Seisdedos, Degena Bahray Bahrey Tadesse, Eugenio Traini, Bach Xuan Tran, Khanh Bao Tran, Irfan Ullah, Marco Vacante, Amir Vahedian-Azimi, Elena Varavikova, Ronny Westerman, Dawit Dawit Zewdu Wondafrash, Rixing Xu, Naohiro Yonemoto, Vesna Zadnik, Zhi-Jiang Zhang, Reza Malekzadeh, Mohsen Naghavi

Abstract

Background: Worldwide, both the incidence and death rates of pancreatic cancer are increasing. Evaluation of pancreatic cancer burden and its global, regional, and national patterns is crucial to policy making and better resource allocation for controlling pancreatic cancer risk factors, developing early detection methods, and providing faster and more effective treatments.

Methods: Vital registration, vital registration sample, and cancer registry data were used to generate mortality, incidence, and disability-adjusted life-years (DALYs) estimates. We used the comparative risk assessment framework to estimate the proportion of deaths attributable to risk factors for pancreatic cancer: smoking, high fasting plasma glucose, and high body-mass index. All of the estimates were reported as counts and age-standardised rates per 100 000 person-years. 95% uncertainty intervals (UIs) were reported for all estimates.

Findings: In 2017, there were 448 000 (95% UI 439 000-456 000) incident cases of pancreatic cancer globally, of which 232 000 (210 000-221 000; 51·9%) were in males. The age-standardised incidence rate was 5·0 (4·9-5·1) per 100 000 person-years in 1990 and increased to 5·7 (5·6-5·8) per 100 000 person-years in 2017. There was a 2·3 times increase in number of deaths for both sexes from 196 000 (193 000-200 000) in 1990 to 441 000 (433 000-449 000) in 2017. There was a 2·1 times increase in DALYs due to pancreatic cancer, increasing from 4·4 million (4·3-4·5) in 1990 to 9·1 million (8·9-9·3) in 2017. The age-standardised death rate of pancreatic cancer was highest in the high-income super-region across all years from 1990 to 2017. In 2017, the highest age-standardised death rates were observed in Greenland (17·4 [15·8-19·0] per 100 000 person-years) and Uruguay (12·1 [10·9-13·5] per 100 000 person-years). These countries also had the highest age-standardised death rates in 1990. Bangladesh (1·9 [1·5-2·3] per 100 000 person-years) had the lowest rate in 2017, and São Tomé and Príncipe (1·3 [1·1-1·5] per 100 000 person-years) had the lowest rate in 1990. The numbers of incident cases and deaths peaked at the ages of 65-69 years for males and at 75-79 years for females. Age-standardised pancreatic cancer deaths worldwide were primarily attributable to smoking (21·1% [18·8-23·7]), high fasting plasma glucose (8·9% [2·1-19·4]), and high body-mass index (6·2% [2·5-11·4]) in 2017.

Interpretation: Globally, the number of deaths, incident cases, and DALYs caused by pancreatic cancer has more than doubled from 1990 to 2017. The increase in incidence of pancreatic cancer is likely to continue as the population ages. Prevention strategies should focus on modifiable risk factors. Development of screening programmes for early detection and more effective treatment strategies for pancreatic cancer are needed.

Funding: Bill & Melinda Gates Foundation.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Levels and trends in age-standardised incidence and death rates of pancreatic cancer across 21 GBD regions by sex (A) The age-standardised incidence rates of pancreatic cancer in 2017. (B) The percentage change in age-standardised incidence rate of pancreatic cancer from 1990 to 2017. (C) The age-standardised death rates of pancreatic cancer in 2017. (D) The percentage change in age-standardised death rate of pancreatic cancer from 1990 to 2017. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 2
Figure 2
Age-specific counts and rates of incident cases (A), deaths (B), and DALYs (C) of pancreatic cancer by sex, 2017 DALYs=disability-adjusted life-years.
Figure 3
Figure 3
Age-standardised rates of incidence (A) and death (B) of pancreatic cancer across 195 countries and territories in both sexes, 2017
Figure 4
Figure 4
Fraction of pancreatic cancer age-standardised deaths attributable to smoking, high fasting plasma glucose, and high body-mass index by region (A) and fraction of pancreatic cancer age-specific deaths attributable to smoking, high fasting plasma glucose, and high body-mass index by age group (B) for males and females, 2017
Figure 5
Figure 5
The trend in age-standardised death rates of pancreatic cancer across 21 GBD regions by SDI for both sexes combined, 1990–2017 For each region, points from left to right depict estimates from each year from 1990 to 2017. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. SDI=Socio-demographic Index.
Figure 6
Figure 6
The age-standardised death rates of pancreatic cancer across 195 countries and territories by SDI in both sexes, 2017 SDI=Socio-demographic Index.

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